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Counseling Couples with Mixed HIV Status

October 2012
By: Sarah Bentley
Today approximately 1,039,000 to 1,185,000 people are living with HIV in America, emphasis on living! Thankfully the treatment for HIV has greatly improved and a person can now live a much longer, normal life*. This means that a person who is HIV-negative has the potential to meet a significant other with a positive HIV status or a person with a positive HIV status could be involved with someone who is not HIV-positive. Couples with mixed HIV status are sometimes called a "serodiscordant" or "mixed serostatus" couple. Other terms are "magnetic" or "serodivergent." This means that in the couple, one person is HIV-positive and one is HIV-negative. "Sero-" refers to blood serum. "Serostatus" refers to whether someone has HIV infection or not**.


Certainly HIV is not the first topic that comes up when most couples start dating. A person may not know about the other's status for quite some time depending on how the relationship develops. Disclosing one's status can be very difficult. There are several pros and cons, but let's propose that both persons in the couple are aware of the situation and may be unsure of where to go from this point. It can be an overwhelming component in a relationship. How then does one sensitively counsel a couple with a mixed status?

Counselor's Role

Once the couple has disclosed the information, how the counselor reacts is crucial. An appropriate first step is to build a relationship with the couple, as this may be a difficult subject for both to disclose. Building rapport is extremely essential when counseling a mixed-status couple, and it is important that the counselor/advocate be aware of the facts regarding HIV and a mixed-status couple. After building rapport and relaying empathy towards the couple, the next step would be to assess the couple's knowledge pertaining to HIV and mixed-status couples. After assessing the couple's needs, becoming an advocate and an educator is highly important. A vital piece is for the counselor to address the couple with compassion, because even in an educated society the couple may face discrimination.

Open Communication

Encouraging open communication between the couple is imperative in assisting the couple in discussing the levels of safety in regards to the person's HIV status. It is also critical for the couple to support one another and have open discussions about needs, fears, and limits**. One person may be more concerned with prevention, while the other person may be more concerned with taking care of the infected person**. These areas are important to address, and it may be wise to refer the couple for other forms of counseling depending on the individual couple's concerns.


People in mixed-status relationships face all the same things as other couples, but there are some added issues. The top areas of concern are stopping the spread of HIV, safety, and security in the relationship. HIV is spread through bodily fluids such as blood, semen, vaginal fluids, and breast milk*. There are several ways for a couple to reduce the risks. Antiviral medications (antiretroviral therapy or ART) can control HIV and lessen the risk of transmission. It is important for a person to maintain his or her ART regimen. Also, the use of condoms can reduce the risk of HIV transmission. Limiting certain activities in times of infection can also lessen the percentage of transmission.

Maintaining a healthy relationship requires effort and support. Those involved in a mixed-status relationship have added stressors; therefore, it is essential that the counselor helps the couple cope by being aware and optimistic about the future as the journey may be difficult but worth the living!

Sarah Bentley, M.A., NCC, Clinical Therapist

*CDC. Protect yourself. Protect others. Retrieved from

**The Body. (2012). Couples With Mixed HIV Status. Retrieved from

Additional Resource:

U.S. Department of Health & Human Services. (2012). When One Partner Is HIV+. Retrieved from

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